Post Operative Instructions

Eating first days

However, most of people don't have much problems with eating with their newly fitted braces, there are certain dietary habits that are known to cause the breakage of Orthodontic appliances as well as increasing the risk of dental disease. At Midtown dental arts, our aim is to achieve the treatment goals with as few treatment issues as possible. By choosing proper diet food, you can ensure that you suffer from no side effects due to poor diet. Be sure to have well-balanced diet & remember that teeth move their best in healthy environment and individuals with excellent overall health.

Potential harm to your teeth and gums

Food that may clog on your teeth and braces should be restricted from eating while you are wearing the braces. Especially sticky food tends to stick to your braces and increase the risk of dental decay and appliance breakage. If sugary food is to be consumed, make sure you consume it with your lunch and also ensure that soon after the meal you vigorously rinse off the plaque or brush your teeth. Between meals, snack should be confined to only non-sugary food, followed by toothbrushing or vigorous rinsing if toothbrush is unavailable.

The following foods can be particularly harmful to your teeth while wearing braces:

• Sticky food or candy of any kind (taffy, caramels, Tootsie Rolls, Gummy Bears, Now & Laters, gum)
• Hard foods or candy of any kind (Jolly Ranchers, ice, beef jerky, Doritos, Fritos, Cornuts)
• Soda pop (including diet soda)
• Popcorn
• Seeds in the shell (sunflower and pumpkin seeds)
• Lemons (Citric acid in juice can dissolve tooth enamel if eaten frequently)

Potential harm to your braces

Braces are attached to your teeth with adhesive which normally stay fitted on it. However, sometimes braces can get dislodged and wires can get broken or bent while eating certain foods. Hard foods such as nuts, hard candy, corn chips and sometimes even crisp taco shlls can harm your braces and should be avoided. Chewing ice cubes, pencils, fingernails etc can also be a factor in damaging your braces appliance. Some food such as whole apples, raw carrots or celery are healthy snacks. However ensure that it is cut into smaller pieces to avoid damage to your braces.

Chewy foods such as caramel and even thick bread can be harmful to your braces. It may bend and distort the wires leading you to extra visits for dental repairs. The husks from popcorn can become clogged beneath the braces and cause irritation to the gum tissue. Unpopped kernels can shear or break off braces as well as bend or dislodge wires.

Remember if you have any questions about dietary restrictions or good food choices, PLEASE ASK!

Initially, the adhesive attached to your braces tends to cure rapidly. After leaving our office on completing your treatment, you can eat almost anything. However, we advice you to avoid hard-foods included in our list until you become accustomed to eating with your new braces. Initially it is adviced to follow the diet consisting soft food only for few days.

Will the braces cause discomfort?

Newly fitted braces can be irritating initially. However, as you get accustomed to your braces and tooth alignment improves, this sensation will cease to be a concern. However brackets are round, it may feel bit inconvenient to wear braces until the inside part of cheeks is toughened properly. If irritation happens, use small piece of wax around the bracket that is creating irritation. If you run out of wax, contact us for more. We also advice to rinse your mouth with warm salt water twice or thrice a dayand utilize orabase gel to soothe cheek irritations.

After few initial hours of wearing braces first time, you may feel some discomfort as some teeth, especially front teeth, are more sensitive to pressure. Gradually, you will stop feeling discomfort. The discomfort with new braces is usually expected to be experienced more in initial eight hours & in most cases it is dissipated within a week. However, exactly when discomfort will vanish depends upon the individual and the time may vary from person to person. Nonprescription pain remedies are recommended for discomfort. For maximum effectiveness, we advice you to take remedies in advance before the pain appears.

Before leaving the office

We advice you follow some steps in advance before leaving our office. These steps will minimize your discomfort related to irritation from the braces and ensure an optimal response during treatment. Please make sure that these steps are part of your every visit.

• There are routine steps that we ask you to take prior to leaving the office. These steps will minimize discomfort related to irritation from the braces and ensure an optimal response to treatment. Please make these steps a part of each office visit:
• With your finger and tongue, check that the wire ends do not extend into areas which might poke or abrade the tongue or cheek. about what to do, what to eat, how to wear elastics as instructed, how to activate expander etc. Also make sure you have properly understood the hygiene and diet instructions.
• Make sure you have an adequate supply of orthodontic wax, special cleaning aids, elastic bands or other related materials you may need between appointments.
• Before leaving the office, make sure always that you have scheduled your next appointment as appointments are scheduled 4-6 week in advance. Waiting for 1-2 weeks after an appointment to schedule the next office visit may complicate the whole schedule and lead you to treatment delays which is extremely not preferable.

Schwarz Appliance

Today you or your child were given a lower expansion appliance that is called a Schwarz expander, named after the developer of this appliance. The purpose of this appliance is to upright the lower posterior teeth, usually making space for the alignment of the front teeth.

Though the lower expander is removable, it is adviced to have it worn most of the times except the time of meal and brushing. However, if the patient is comfortable with expander during eating, it is adviced to do so. After meal, when the appliance is brought out of the mouth to clean it, make sure that it is not left wrapped in napkin particularly when eating at restaurant, as the expander can be lost this way. Whenever not worn, the lower expander should be placed in its given case so that no damage to it happens.

The schwarz appliance is very delicate and fragile, causing it to be easily bent or distorted, In order to put it safe, it is adviced to take utmost care of it. If you see your child flipping the appliance around with toungue or bitting the appliance down into place, make sure you discourage him to do so. Your child is adviced to in and out of his mouth with his fingers gentally.

As your child wears the schwarz appliance, ocassionally one or more of the metal clasps may break off. This is only of concern if your child is unable to wear the Schwarz appliance as directed. If the broken clasp is sharp and uncomfortable, making it difficult to wear, please call Midtown dental arts to schedule a quick fix appointment as soon as possible.

There is an additional charge to replace a lost or negligently broken Schwarz. Should this become necessary, additional impressions must be taken. Dental casts are damaged when making the Schwarz and are not reusable.

Everytime the patient brushes his teeth, the Schwarz appliance should be cleaned. Toothpaste can be applied with a toothbrush. Effervescent denture cleaner (like "Efferdent") can also be used if needed. Do not use hot water as this plastic-type appliance will warp. During the active phase of wear, the appliance should be activated once per week. For doing this turn the expansion screw 90 degrees, using the key provided, in the direction indicated by the arrow on the appliance.

If you have any questions, or if any problems are encountered in wearing the appliance, please contact the office immediately.

Expander Removal

We have just removed the bonded rapid palatal expansion appliance from the upper arch of your child's teeth. You will notice that the tissue surrounding the teeth in the posterior part of the mouth may be red and irritated and may bleed easily. This is the usual occurrence following expander removal. In most instances, the irritation will disappear within two or three days.

There are two methods of retention commonly used. The first method is called a maintenance plate. The purpose of this plate is to maintain the expansion that was achieved through the use of the bonded expander. If a plate is to be used, an impression was taken today, and the plate will be delivered at the next appointment.

The maintenance plate should be worn all of the time except when brushing. Many children find it easier to leave the plate in the mouth during meals than to remove it. Hard and sticky foods should be avoided in this case. If your child must take it out to eat, care must be taken to replace it immediately after the meal.

Any time the maintenance plate is taken out of the mouth, it should be placed in a container to prevent loss or damage. At home, it is usually convenient to identify one place (for example, in the kitchen) where the appliance is put after taking it out of the mouth. A dish or cup on the kitchen counter is often ideal.

When removing the plate at school, the appliance should be placed in the retainer box that will be given to your child. It should be stored in the school desk or in some other safe area.

The biggest problem with wearing any removable appliance is losing the appliance. Make sure that your child does not wrap the plate in a napkin when eating at restaurants or at school. Very often, the napkin is thrown away, and with it, the retainer. If a replacement plate is indicated, an additional impression is needed as the cast is destroyed in the fabrication process when making any retainer. There is a replacement charge for any lost appliance.

Rapid Palatal Expander

You have (or your child has) received a rapid palatal expander. This appliance orthopedically widens tile upper jaw by separating the midpalatal suture. This procedure also allows for the creation of more space for the eruption of the permanent teeth.

There are two types of expanders. The first is a BONDED expander. This appliance is bonded (or glued) to the posterior teeth. This bonded expander not only covers the outside and inside edges of the posterior teeth, but also covers the biting surfaces of the back teeth. Thus, it is normal for the front teeth not to jut as they did before die appliance was placed.

The second type of expander is a BANDED type. In adolescent patients or adults whose permanent teeth have erupted, the appliance is fixed to the first bicupids and first molars by the use of orthodontic bands. Both of these appliances transmit the force of the jackscrew through the teeth to the underlying bony support.

The appliance is to be activated once per day, usually at bedtime. You have been given a special wrench for activating the appliance. The appliance is activated in the following manner:

1. The patient should lay on a flat surface, such as a bed. It is helpful if there is a source of light, such as a reading light, available so that the inside of the mouth can be illuminated.
2. The appliance is activated by inserting the wrench at the midline of the appliance. The wrench is rotated downward and backward as the wrench moves toward the throat. The wrench should be pushed posteriorly until it touches the lower teeth
3. The wrench should be removed from the appliance and rotated and the repeat step 2. Do not deactivate the appliance by pulling the wrench anteriorly as you remove it from the appliance.
4. During and immediately following the activation. of the appliance, some pressure may be experienced by the patient at the bridge of the nose, in the region of the cheeks, or between the front teeth. This feeling of pressure is to be expected as the appliance is activated.
5. After about one week of activation, a space usually opens between the two upper front teeth. The appearance of the space is an excellent indication that treatment is progressing as expected. The space will continue to increase with subsequent activations. Occasionally, these front teeth will become slightly mobile and sensitive. This will subside within a short period of time. Discomfort can be relieved by taking ibuprofen (Advil, Nuprin) or Tylenol.
6. After activation of the appliance has been discontinued, there will be a gradual closure of the midline space spontaneously. The upper front teeth will tend to drift and tip together. This closure of the space is to be expected, because the fibers that connect the teeth have been stretched, and the teeth will move together on their own. The closure of the space is not a sign that the treatment is becoming unsuccessful.

First or two days after wearing appliance can be frustrating as it is not too easy to adapt the change with soft tissues of mouth. However, we have found that patience, positive attitude and warm encouragement can help the patient to quickly adopt the situation. Following are some helpful ideas that will ease this adjustment period.

Some tooth tenderness is normal and can be relieved by taking ibuprofen (Advil, Nuprin) or Tylenol. Usually speech and eating difficulties are resolved within 24-72 hours. It also can be helpful to read out loud for a few days until speech improves. It is also helpful to eat ofter food and meals until the patient has been accustomed to eat the day-to-day food and feeling of braces. Initially, a cold treat of ice cream or Popsicle's may relieve some uncomfortable symptoms and help the patient become accustomed to eating with the appliance in place. However, this shouldn't become habit due to high amount of sugary content. We suggest nutritious dishes like pasta (macaroni and cheese, spaghetti, casseroles), soup, cereal, applesauce and yogurt. Within a few days, the patient should be able to eat almost anything allowed on the 'Brace Watchers Diet".

During meals, food may accumulate between the roof of the mouth and the appliance. It is best to finish the meal or snack first, then dislodge the food by swishing around a mouth full of your drink. It is important to use the "swish and swallow" method. Trying to suck the inaterial from the appliance may cause the food particles to become lodged in the lungs. This could lead to a serious lungs infection.

It is very important to have the space between the appliance and your mouth roof cleaned properly daily, preferably with water pik if it is available. If food particles remain under the appliance, they may become a source of irritation to the roof of the mouth resulting in to oral discomfort for the patient. In extreme cases, it may result in oral infection.

Today we have reviewed tooth brushing instructions. It is adviced to pay more attention to the marginal area where the appliance meets gums on cheek side and the tongue side. Improper brushing can leave heavy plaque buildup which can result in gum problems, especially Gingivitis. If you notice the gums bleeding, especially during brushing, it may be sign of gingivitis and can be eliminated within 2 to 4 days with adequate plaque removal when brushing.

If the appliance becomes loose or if there is pain or extreme breath odor, call the office immediately. If the patient thinks that the appliance feels loose, even though not visibly, the patient should be seen.

During the time of activation of aplliance, it is very important for patient to keep visiting the office every two-three weeks. If in any case, patient misses the appointment, expanding should be discontinued till the next visit. In such case, please call Midtown dental arts promptly to reschedule the appointment.

If you have any questions regarding the management of this appliance, or any other aspect of treatment, please call the office immediately.